急性心肌梗死后心源性休克患者早期发生急性肾功能衰竭与预后的关系

目的 了解急性心肌梗死后心源性休克患者中早期发生急性肾功能衰竭与预后的关系。方法回顾性分析解放军总医院 1993— 2 0 0 3年因急性心肌梗死或冠心病心绞痛住院、并出现心源性休克患者的临床资料。以 2 4 h内是否出现急性肾功能衰竭为标准 ,比较其住院期间病死率 ;并采用多元 logistic回归分析 ,评估早期发生急性肾功能衰竭对患者预后的影响。结果 172例患者中 ,5 1例 ( 30 % )于 2 4 h内出现急性肾功能衰竭。早期是否发生急性肾功能衰竭患者的住院病死率分别为 90 % ( 4 6 / 5 1例 )和 5 6 % ( 6 8/ 12 1例 )。逐步回归分析表明 ,早期发生急性肾功能衰竭是影响急性心肌梗死后心源性休克患者预后的独立因素 ,相对危险度 ( OR) =6 .7,95 %可信区间为 2 .5～ 18.0 ,P<0 .0 0 1。结论 急性心肌梗死后心源性休克患者 ,早期急性肾功能衰竭的发生与患者住院病死率显著相关 。

40例多器官衰竭时急性肾功能衰竭的临床分析

目的：探讨多器官衰竭（ＭＯＦ）时急性肾功能衰竭（ＡＲＦ）的更为有效的防治手段，防止和阻断其进一步发展，改善ＭＯＦ的预后。方法：对４０例ＭＯＦ合并ＡＲＦ的病例资料进行临床分析。结果：ＭＯＦ的主要原发病因是感染（７０．０％），其次是创伤（２２．５％），其它占７．５％；本组患者的病死率６５．０％，且随衰竭器官的数目增多而病死率升高。ＡＲＦ表现为少尿型８７．５％，非少尿型１２．５％。采用血液透析（ＨＤ）治疗２２例中存活１２例，死亡１０例，病死率５４．５％；非ＨＤ治疗１８例中存活２例，死亡１６例，病死率８８．９％，比较此两种治疗方法的疗效ＨＤ组明显高于非ＨＤ组（Ｐ＜０．０１）。结论：对于ＭＯＦ时ＡＲＦ的治疗，首先应针对各器官衰竭的治疗；积极有效地控制感染是抢救成功的关键；早期充分的血液净化是治疗的重要环节；辅助支持疗法，提高免疫功能，改善组织缺氧，禁止应用对肾脏有损害的药物，对改善本病的预后具有重要意义。

体外循环心脏直视手术后发生急性肾功能衰竭的高危因素

目的：用单因素和多因素统计的方法，对心脏手术围术期可能与急性肾功能衰竭（ＡＲＦ）发生有关的因素进行回顾性分析，筛选出可能的高危因素。方法：以９１例体外循环（ＣＰＢ）心脏直视手术后ＡＲＦ病例为对象，并随机选择同期１８２例相同病种心脏直视手术后无并发症的病例，以１∶２进行配对。从上述两组２７３份病例中摘录可能与心脏手术后ＡＲＦ发生有关的术前、术中和术后３４项因素，单因素分析比较两组间有统计学意义的变量。然后，以这些因素为自变量，以是否发生ＡＲＦ为因变量，进行多元逐步和Ｌｏｇｉｓｔｉｃ回归分析。结果和结论：术前有肾脏疾病史、术前肾功能异常、术中大量输血、术中发生手术意外、术后严重心律失常、术后低心排、术后依赖辅助呼吸时间延长、术后第１天少尿是ＣＰＢ心脏直视手术后发生ＡＲＦ的高危因素。

肾病综合征合并急性肾功能衰竭——附13例分析

目的：探讨原发性肾病综合征（ＮＳ）合并急性肾功能衰竭（ＡＲＦ）的诊断及治疗。方法：对１３例ＮＳ合并ＡＲＦ患者进行临床分析。结果：ＮＳ患者均有高度浮肿、大量蛋白尿、严重低蛋白血症、肾损害，无低血容量表现。其中１０例肾活检病理资料显示ＮＳ合并ＡＲＦ多发生在肾小球病变轻微的患者。予激素及呋塞米治疗有效，２例病情严重者，需血透治疗。结论：ＮＳ合并ＡＲＦ易发生于肾小球病变轻微者。

肾病综合征并发急性肾功能衰竭16例

肾病综合征（ＮＳ）并发急性肾功能衰竭（ＡＲＦ）较少报道。本院自１９８８年１月至１９９７年１２月共收治ＮＳ３１０人，其中并发ＡＲＦ者１６人，获得满意疗效。１临床资料１．１病例来源和诊断标准本组患者均为住院病人，男１０例，女６例。年龄１８～６５岁，平均４...

老年急性肾功能衰竭34例临床分析

对３４ 例老年急性肾功能衰竭（ Ａ Ｒ Ｆ） 临床分析结果表明：老年人由肾小球疾病所致的 Ａ Ｒ Ｆ 减少，而肾前因素、肾毒性药物、感染、创伤所致者增多，且老年人 Ａ Ｒ Ｆ 病死率仍高。提示老年人应注意补充液体，合理使用肾毒性药物，预防 Ａ Ｒ Ｆ 的发生。

异搏定和环孢素A对急性缺血性肾损伤后内皮素的影响

目的：观察内皮素（ＥＴ）在急性缺血性肾损伤后的变化及异搏定对肾的保护作用和环孢素Ａ（ＣｓＡ）肾毒性与ＥＴ之间的关系。方法：通过阻断大鼠肾动脉６０分钟造成急性缺血性肾功能衰竭（ＩＡＲＦ）模型，用放射免疫方法测定肾脏缺血再灌注１小时、６小时和２４小时血浆及肾组织中ＥＴ的变化；同时观察异搏定和ＣｓＡ对ＥＴ肾功能的影响。结果：ＩＡＲＦ时，血浆及肾组织中ＥＴ在３个时间点均有不同程度的升高；异搏定可降低ＩＡＲＦ大鼠血浆和肾组织中的ＥＴ含量；ＣｓＡ引起ＥＴ活性进一步升高，并加重肾损伤。结论：ＥＴ可能是导致ＩＡＲＦ的一个重要因子；异搏定能抑制ＩＡＲＦ时ＥＴ的分泌和释放而保护肾脏；ＣｓＡ的肾毒性可能与其诱导ＥＴ的分泌和释放有关。

血液净化治疗横纹肌溶解综合征

2000年5月-2006年11月，我院重症加强治疗病房（ICU）采用血液净化治疗35例横纹肌溶解综合征（RM）患者，报告如下。

Cardiorenal biomarkers in acute heart failure

Managing patients with heart failure （HF） is a challenging task within itself, but the presence of associated worsening renal function can greatly increase mortality and morbidity. Early diagnosis and treatment is the key to prevent re-hospitalizations and reduce healthcare costs. Biomarkers have long been established as highly sensitive and specific tools in diagnosing and prognosticating patients with HF. Reflecting distinct pathophysiological events and ongoing cellular insult, biomarkers have been proven superior to conventional laboratory tests. Availability of better assays and rapid analysis has allowed the use of biomarkers as point-of-care tests in the emergency department and at the patient＇s bed-side. Acute HF patients often go on to develop worsening renal function, termed as acute cardiorenal syndrome. The growing breadth of studies has shown the implications of combining multiple biomarkers to better chart outcomes and produce desirable results in such patients.

Hemorrhagic Fever with Renal Syndrome Complicated by Orchitis

Hemorrhagic fever with renal syndrome (HFRS) is a disease caused by viruses of the family Bunyaviridae,genus Hantavirus.HFRS from Dobrava virus (DOBV) is a seldom reported disease in Albania.Clinically HFRS is manifested as mild,moderate,or severe.Therefore,the number of cases of Hantavirus' infection may be underestimated,and should be included in the differential diagnosis of many acute infections,hematologic diseases,acute abdominal diseases and renal diseases complicated by acute renal failure.We report here an atypical presentation of HFRS from Dobrava virus complicated by orchitis with a positive outcome.

Sorafenib induced tumor lysis syndrome in an advanced hepatocellular carcinoma patient

A 55-year-old male patient with hepatitis B-related liver cirrhosis was found to have advanced hepatocellular carcinoma.His AFP was initially 9828μg/L and rapidly dropped to 5597μg/L in ten days after oral sorafenib treatment.However,he developed acute renal failure, hyperkalemia,and hyperuricemia 30 d after receiving the sorafenib treatment.Tumor lysis syndrome was suspected and intensive hemodialysis was performed. Despite intensive hemodialysis and other supportive therapy,he developed multiple organ failure(liver, renal,and respiratory failure)and metabolic acidosis. The patient expired 13 d after admission.

Hepatorenal syndrome

Hepatorenal syndrome(HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension.This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys,where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration,which ultimately results in uraemia.The syndrome occurs almost exclusively in patients with ascites.Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output.Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure,but refractory ascites,and its impact on prognosis is less negative.Liver transplantation is the most appropriate therapeutic method,nevertheless,only a few patients can receive it.The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response.Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term.Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.

Prediction of nephrotoxicity induced by cisplatin combination chemotherapy in gastric cancer patients

AIM:To evaluate the treatment options for nephrotoxicity due to cisplatin combination chemotherapy.METHODS:We retrospectively reviewed patients who had received cisplatin combination chemotherapy for gastric cancer between January 2002 and December 2008.We investigated patients who had shown acute renal failure(ARF),and examined their clinical characteristics,laboratory data,use of preventive measures,treatment cycles,the amount of cisplatin administered,recovery period,subsequent treatments,and renal status between the recovered and unrecovered groups.RESULTS:Forty-one of the 552 patients had serum creatinine(SCR)levels greater than 1.5 mg/dL.We found that pre-ARF SCR,ARF SCR,and ARF glomerular filtration rates were significantly associated with renal status postARF between the two groups(P=0.008,0.026,0.026,respectively).On the receiver operating characteristic curve of these values,a 1.75 mg/dL ARF SCR value had 87.5%sensitivity and 84.8%specificity(P=0.011).CONCLUSION:Cessation or reduction of chemotherapy should be considered for patients who have an elevation of SCR levels during cisplatin combination chemotherapy.

Hepatic failure caused by plasma cell infiltration in multiple myeloma

Although plasma cell infiltration is not rare in autopsy of patients with multiple myeloma （MM）, it is very rarely detected in living patients. This is because MM rarely causes significant liver dysfunction that requires further evaluation. A 49-year-old man presented with acute renal failure and was diagnosed with kappa light chain MM stageⅡB. Thalidomide and dexamethasone were initiated. The patient developed a continuous increase in bilirubin that led to severe cholestasis. A liver biopsy revealed plasma cell infiltration. He then rapidly progressed to liver failure and died. Treatment options are limited in MM with significant liver dysfunction. Despite new drug therapies in MM, those patients with rapidly progressive liver failure appear to have a dismal outcome.

A population-based case-crossover study of polyethylene glycol use and acute renal failure risk in the elderly

AIM:To evaluate the possibility of an association between polyethylene glycol(PEG) and acute renal failure(ARF) in elderly patients using a health insurance claims database.METHODS:We conducted a population-based casecrossover study using information obtained from Korean Health Insurance Review and Assessment Service(HIRA) claims from January 1,2005 to December 31,2005(Seoul,Korea).The study population consisted of elderly patients who received PEG prior to experiencing their first ARF-related hospitalization from April 1,2005 to December 31,2005.For each patient,one case and two control periods were matched.PEG use in a 2-or 4-wk window period prior to hospitalization for ARF was compared with PEG use in two earlier 2-or 4-wk control window periods.Conditional logistic regression analysis was used to estimate odds ratios(ORs) and 95% CI,adjusting for concomitant uses of diuretics,angiotensin converting enzyme inhibitors,non-steroidal anti-inflammatory drugs,antibiotics,anti-cancer drugs,and contrast media.RESULTS:Within the HIRA database which contained 1 093 262 elderly patients,1156 hospitalized ARF cases were identified.Among these cases,PEG was prescribed to 17(1.5%) patients before hospitalization.The adjusted ORs when applying the 2-and 4-wk window periods were 0.4(95% CI:0.03-5.24) and 2.1(95% CI:0.16-27.78),respectively.CONCLUSION:No increased risk of ARF was found in elderly PEG users.However,based on the limited number of study subjects,further analysis should be performed to confirm these results.

A retrospective study of continuous renal replacement therapy versus intermittent hemodialysis in severe acute renal failure

Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF patients who received renal support between December 1978 and December 1998 were involved in this study.Of them,101(52.3%)were treated with CRRT(CRRT group),and 92(47.7%)with IHD(IHD group).Results Sixty(59.4%)patients in the CRRT group got through the acute phase of disease and 41 (40.6%)patients did not survive while in the IHD group 59(64.1%)patients survived and 33(35.9%)patients did not.No significant difference in survival rate was found between the two groups.24 of 64 patients(37.5%)in the CRRT group with multiple organ dysfunction syndrome(MODS)survived,while in the IHD group,8 out of 44(27.3%)survived,their survival rate was much lower than that in the CRRT group.Patients in CRRT group were more severely iii,as manifested by lower mean arterial pressure,higher APACHE Ⅱ score,more dysfunctioned organs and requiring mechanical ventilation and vasopressor support as compared with patients in the IHD group,CRRT was found to improve hemodynamic stability with a better fluid balance and control of biochemical status,increased nutritional intake and a shorter duration of acute renal failure(P ＜ 0.05).Conclusion CRRT perhaps may be the best choice in the treatment of severe ARF patients,for it can offer several distinct advantages compared to IHD.These may contribute to improving the survival rate of ARF patients,particularly those that are critically ill patients.

Postoperative mortality and morbidity in octogenarians and nonagenarians with hip fracture： an analysis of perioperative risk factors

Objective： To evaluate the role of high risk factors in octogenarians and nonagenarians with hip trauma, which may lead to excessive mortality and morbidity postoperatively. Methods： Fifty-four octogenarians and nonagenarians patients were enrolled in the study, receiving surgical repair of hip fracture in our hospital from January 2006 to January 2010. High risk factors were recorded preoperatively in detail. Complications and survival state were followed up by telephone for 2 years postoperatively. All the data were analyzed by Chi-square test with SPSS 13.0. Results： Twenty-six males （48.1%）, aged from 80 to 94 years with a mean age of 84.2 years, and twenty-eight females （51.9%）, aged from 80 to 95 years with a mean age of 83.4 years, were presented in the cohort study. The hip traumas were caused by daily slight injuries （52 cases） and car accidents （2 cases）, respectively. Twenty-eight patients （51.9%） with femoral neck fracture while 26 patients （48.1%） with intertrochanteric fracture were diagnosed through an anterior-posterior pelvic radiophotograph. In this series, 39 patients （72.2%） suffered from one or more comorbidities preoperatively. The morbidity was 48.1% and the major cause was urinary tract infection, while a significant difference was noted between females and males. The mortality was 20.4% with a predominant cause of acute renal failure. Conclusions： The gender should be considered as a critical high risk factor in octogenarians and nonagenarians with hip trauma postoperatively. Females are more likely to suffer complications postoperatively, which is especially obvious in senile patients over 80 years （P〈0.05）. Urinary tract infection is the most frequent complication after hip surgery, followed by low limb embolism and malnutrition. The mortality is dramatically greater in patients over 80 years old than those below, and major causes are acute renal failure, multiple organ dysfunction syndrome and mental deterioration. Multidisciplinary consultations and mental assessment are encouraged in patients over 80 years old after hip trauma and surgery. Hip fractures in octogenarians and nonagenarians deserve special attention because of their advanced age and comorbidities.